Effects of a Fully Immersive Virtual Reality Exercise Game on Fear of Movement, Pain, and Disability in People with Chronic Non-Specific Low Back Pain: A Pilot Randomized Controlled Trial

Background/Objectives: Low back pain (LBP) is a leading cause of disability worldwide, and exercise-based rehabilitation is recognized as an effective management strategy. However, adherence to exercise remains challenging. Fully immersive virtual reality (VR) exercise interventions may enhance engagement and clinical outcomes. This study aimed to examine the effect of a fully immersive VR exercise game on pain, fear-avoidance beliefs, and disability in individuals with chronic non-specific LBP. Methods: A single-blinded randomized controlled trial was conducted, involving 28 participants aged 18–60 years with chronic non-specific LBP. Participants were randomly allocated to either a VR exercise group with standard education (n = 14) or a conventional home exercise group with standard education (n = 14). Both groups performed their assigned intervention once per day for two weeks. Outcomes included the Fear-Avoidance Beliefs Questionnaire (FABQ), Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Back Beliefs Questionnaire (BBQ), and functional performance tests (six-minute walk test, repeated sit-to-stand, and trunk flexion). Measures were assessed at baseline and after a 2-week intervention period. Exercise adherence was recorded using a self-reported log. Results: No significant within- or between-group differences were observed for FABQ scores. However, a significant between-group difference was reported for pain reduction in the VR group (p = 0.044). No significant differences were reported for disability or belief-related outcomes, or for physical performance outcomes, including the 6 min walk test, repeated sit-to-stand test, and trunk flexion test. Conclusions: A fully immersive VR exercise intervention resulted in greater short-term pain reduction compared to conventional exercise in individuals with chronic non-specific LBP. However, it had little impact on fear-avoidance beliefs or disability, highlighting the need for multimodal approaches that address broader biopsychosocial factors.